| Michael Montgomery | |
|
2605 Emerson Ave N Minneapolis MN 55411-2011 | |
| (612) 296-1514 | |
| Not Available |
| Full Name | Michael Montgomery |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 2605 Emerson Ave N, Minneapolis, Minnesota |
| Authorized Official Name and Position | Michael Israel Montgomery (OWNER) |
| Authorized Official Contact | 6125209177 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Michael Montgomery 2605 Emerson Ave N Minneapolis MN 55411-2011 Ph: (612) 296-1514 | Michael Montgomery 2605 Emerson Ave N Minneapolis MN 55411-2011 Ph: (612) 296-1514 |
| NPI Number | 1073800934 |
|---|---|
| Provider Enumeration Date | 06/29/2011 |
| Last Update Date | 06/29/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1073800934 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | 2102 (Minnesota) | Primary |
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